PDF EXAM
NURS 6501 / NURS6501, Advanced
Pathophysiology Week 11 Quiz (3 sets)
| 125 Questions and Answers | Latest
(Scored 100%)
Set 1: Male Genitourinary Disorders (Questions 1-42)
Question 1: A 65-year-old male presents with nocturia, weak urine stream, and
hesitancy. Digital rectal exam reveals an enlarged, rubbery prostate. What is the
primary pathophysiological mechanism underlying benign prostatic hyperplasia
(BPH)?
A. Malignant transformation of prostatic epithelial cells
B. Dihydrotestosterone (DHT)-mediated stromal and epithelial proliferation
C. Chronic bacterial infection leading to glandular atrophy
D. Autoimmune destruction of prostatic smooth muscle
B. Dihydrotestosterone (DHT)-mediated stromal and epithelial proliferation
Rationale: BPH is a non-malignant enlargement of the prostate driven by
androgens, particularly DHT, which is converted from testosterone by 5 -alpha
reductase. DHT binds to androgen receptors, promoting hyperplasia in the
transitional zone, leading to urethral compression and lower urinary tract
symptoms (LUTS). This is supported by histological evidence of nodular
hyperplasia and elevated DHT levels in affected tissues.
Question 2: In prostate cancer, which genetic alteration is most commonly
associated with the transition from androgen-dependent to castration-resistant
disease?
A. PTEN tumor suppressor gene mutation
B. BRCA1 germline mutation
C. AR amplification and splice variant expression
D. TP53 loss-of-function mutation
C. AR amplification and splice variant expression
GRADED A+
, PDF EXAM
Rationale: Castration-resistant prostate cancer (CRPC) often involves androgen
receptor (AR) pathway reactivation through AR gene amplification, mutations, or
expression of splice variants like AR-V7, which function independently of ligand
binding. This allows continued tumor growth despite low androgen levels post -
androgen deprivation therapy.
Question 3: A patient with BPH develops acute urinary retention. What
pathophysiological change in the bladder most likely contributes to this
complication?
A. Detrusor muscle hypertrophy and decompensation
B. Increased alpha-adrenergic tone in the prostate
C. Urethral stricture from chronic inflammation
D. Neurogenic bladder from spinal cord compression
A. Detrusor muscle hypertrophy and decompensation
Rationale: Chronic obstruction from BPH leads to detrusor hypertrophy as the
bladder compensates for increased workload. Over time, decompensation occurs,
reducing contractility and causing retention. This is a classic sequela of static and
dynamic obstruction in BPH.
Question 4: Which biomarker is most specific for monitoring prostate cancer
progression after radical prostatectomy?
A. Total PSA
B. Free PSA percentage
C. Prostate Health Index (phi)
D. Gleason score
A. Total PSA
Rationale: Post-prostatectomy, undetectable PSA (<0.1 ng/mL) indicates
successful removal. Rising levels suggest biochemical recurrence due to residual or
metastatic disease, making total PSA the gold standard for monitoring.
Question 5: In a 70-year-old male with BPH, what role does insulin-like growth
factor (IGF) play in pathogenesis?
A. Inhibits 5-alpha reductase activity
B. Promotes epithelial proliferation synergistically with DHT
C. Induces apoptosis in stromal cells
D. Reduces prostate vascular permeability
GRADED A+
, PDF EXAM
B. Promotes epithelial proliferation synergistically with DHT
Rationale: IGF signaling, upregulated in BPH, cooperates with DHT to drive
epithelial and stromal hyperplasia, contributing to glandular enlargement and
nodule formation in the transitional zone.
Question 6: A biopsy reveals prostate cancer with a Gleason score of 8. What does
this indicate about tumor aggressiveness?
A. Low-grade, indolent growth
B. High-grade, poorly differentiated cells
C. Intermediate differentiation with low metastatic potential
D. Mucinous subtype with favorable prognosis
B. High-grade, poorly differentiated cells
Rationale: Gleason scores of 8-10 signify high-grade cancer with architectural
disorganization and poor differentiation, correlating with aggressive behavior,
higher PSA levels, and increased metastasis risk.
Question 7: What is the primary site of origin for most prostate cancers?
A. Transitional zone
B. Peripheral zone
C. Central zone
D. Anterior fibromuscular stroma
B. Peripheral zone
Rationale: Over 70% of prostate cancers arise in the peripheral zone, detectable by
digital rectal exam as palpable nodules, due to higher susceptibility to genetic
alterations in this acinar-rich area.
Question 8: In BPH, which neurotransmitter mediates dynamic urethral
obstruction?
A. Acetylcholine
B. Norepinephrine
C. Dopamine
D. Serotonin
B. Norepinephrine
GRADED A+
, PDF EXAM
Rationale: Alpha-1 adrenergic receptors in prostatic smooth muscle respond to
norepinephrine, causing contraction and dynamic obstruction, exacerbating LUTS
in BPH.
Question 9: A patient with metastatic prostate cancer develops osteoblastic bone
lesions. What cytokine is primarily responsible?
A. RANKL
B. TGF-beta
C. IL-6
D. PDGF
D. PDGF
Rationale: Prostate cancer cells secrete PDGF, stimulating osteoblast proliferation
and leading to sclerotic, osteoblastic metastases, a hallmark of advanced disease.
Question 10: Which risk factor for prostate cancer is most strongly associated with
aggressive disease in African American men?
A. Family history
B. Obesity
C. Smoking
D. Diet high in red meat
A. Family history
Rationale: Hereditary factors, including BRCA2 mutations, confer a 2-3 fold
increased risk, with African American men showing higher incidence of
aggressive, high-grade tumors due to genetic predispositions.
Question 11: In BPH, what histological feature distinguishes it from prostate
cancer?
A. Glandular invasion of stroma
B. Nodular hyperplasia without atypia
C. Perineural invasion
D. High mitotic index
B. Nodular hyperplasia without atypia
Rationale: BPH shows well-formed nodules of hyperplastic epithelium and stroma
without cellular atypia or invasion, unlike the disorganized, atypical glands in
cancer.
GRADED A+
NURS 6501 / NURS6501, Advanced
Pathophysiology Week 11 Quiz (3 sets)
| 125 Questions and Answers | Latest
(Scored 100%)
Set 1: Male Genitourinary Disorders (Questions 1-42)
Question 1: A 65-year-old male presents with nocturia, weak urine stream, and
hesitancy. Digital rectal exam reveals an enlarged, rubbery prostate. What is the
primary pathophysiological mechanism underlying benign prostatic hyperplasia
(BPH)?
A. Malignant transformation of prostatic epithelial cells
B. Dihydrotestosterone (DHT)-mediated stromal and epithelial proliferation
C. Chronic bacterial infection leading to glandular atrophy
D. Autoimmune destruction of prostatic smooth muscle
B. Dihydrotestosterone (DHT)-mediated stromal and epithelial proliferation
Rationale: BPH is a non-malignant enlargement of the prostate driven by
androgens, particularly DHT, which is converted from testosterone by 5 -alpha
reductase. DHT binds to androgen receptors, promoting hyperplasia in the
transitional zone, leading to urethral compression and lower urinary tract
symptoms (LUTS). This is supported by histological evidence of nodular
hyperplasia and elevated DHT levels in affected tissues.
Question 2: In prostate cancer, which genetic alteration is most commonly
associated with the transition from androgen-dependent to castration-resistant
disease?
A. PTEN tumor suppressor gene mutation
B. BRCA1 germline mutation
C. AR amplification and splice variant expression
D. TP53 loss-of-function mutation
C. AR amplification and splice variant expression
GRADED A+
, PDF EXAM
Rationale: Castration-resistant prostate cancer (CRPC) often involves androgen
receptor (AR) pathway reactivation through AR gene amplification, mutations, or
expression of splice variants like AR-V7, which function independently of ligand
binding. This allows continued tumor growth despite low androgen levels post -
androgen deprivation therapy.
Question 3: A patient with BPH develops acute urinary retention. What
pathophysiological change in the bladder most likely contributes to this
complication?
A. Detrusor muscle hypertrophy and decompensation
B. Increased alpha-adrenergic tone in the prostate
C. Urethral stricture from chronic inflammation
D. Neurogenic bladder from spinal cord compression
A. Detrusor muscle hypertrophy and decompensation
Rationale: Chronic obstruction from BPH leads to detrusor hypertrophy as the
bladder compensates for increased workload. Over time, decompensation occurs,
reducing contractility and causing retention. This is a classic sequela of static and
dynamic obstruction in BPH.
Question 4: Which biomarker is most specific for monitoring prostate cancer
progression after radical prostatectomy?
A. Total PSA
B. Free PSA percentage
C. Prostate Health Index (phi)
D. Gleason score
A. Total PSA
Rationale: Post-prostatectomy, undetectable PSA (<0.1 ng/mL) indicates
successful removal. Rising levels suggest biochemical recurrence due to residual or
metastatic disease, making total PSA the gold standard for monitoring.
Question 5: In a 70-year-old male with BPH, what role does insulin-like growth
factor (IGF) play in pathogenesis?
A. Inhibits 5-alpha reductase activity
B. Promotes epithelial proliferation synergistically with DHT
C. Induces apoptosis in stromal cells
D. Reduces prostate vascular permeability
GRADED A+
, PDF EXAM
B. Promotes epithelial proliferation synergistically with DHT
Rationale: IGF signaling, upregulated in BPH, cooperates with DHT to drive
epithelial and stromal hyperplasia, contributing to glandular enlargement and
nodule formation in the transitional zone.
Question 6: A biopsy reveals prostate cancer with a Gleason score of 8. What does
this indicate about tumor aggressiveness?
A. Low-grade, indolent growth
B. High-grade, poorly differentiated cells
C. Intermediate differentiation with low metastatic potential
D. Mucinous subtype with favorable prognosis
B. High-grade, poorly differentiated cells
Rationale: Gleason scores of 8-10 signify high-grade cancer with architectural
disorganization and poor differentiation, correlating with aggressive behavior,
higher PSA levels, and increased metastasis risk.
Question 7: What is the primary site of origin for most prostate cancers?
A. Transitional zone
B. Peripheral zone
C. Central zone
D. Anterior fibromuscular stroma
B. Peripheral zone
Rationale: Over 70% of prostate cancers arise in the peripheral zone, detectable by
digital rectal exam as palpable nodules, due to higher susceptibility to genetic
alterations in this acinar-rich area.
Question 8: In BPH, which neurotransmitter mediates dynamic urethral
obstruction?
A. Acetylcholine
B. Norepinephrine
C. Dopamine
D. Serotonin
B. Norepinephrine
GRADED A+
, PDF EXAM
Rationale: Alpha-1 adrenergic receptors in prostatic smooth muscle respond to
norepinephrine, causing contraction and dynamic obstruction, exacerbating LUTS
in BPH.
Question 9: A patient with metastatic prostate cancer develops osteoblastic bone
lesions. What cytokine is primarily responsible?
A. RANKL
B. TGF-beta
C. IL-6
D. PDGF
D. PDGF
Rationale: Prostate cancer cells secrete PDGF, stimulating osteoblast proliferation
and leading to sclerotic, osteoblastic metastases, a hallmark of advanced disease.
Question 10: Which risk factor for prostate cancer is most strongly associated with
aggressive disease in African American men?
A. Family history
B. Obesity
C. Smoking
D. Diet high in red meat
A. Family history
Rationale: Hereditary factors, including BRCA2 mutations, confer a 2-3 fold
increased risk, with African American men showing higher incidence of
aggressive, high-grade tumors due to genetic predispositions.
Question 11: In BPH, what histological feature distinguishes it from prostate
cancer?
A. Glandular invasion of stroma
B. Nodular hyperplasia without atypia
C. Perineural invasion
D. High mitotic index
B. Nodular hyperplasia without atypia
Rationale: BPH shows well-formed nodules of hyperplastic epithelium and stroma
without cellular atypia or invasion, unlike the disorganized, atypical glands in
cancer.
GRADED A+
